Asthma unmasked with tumor necrosis factor-α-blocking drugs

• Published in: Chest Vol. 140; no. 4; p. 1068
• Main Authors: Guilleminault, Laurent, Carré, Philippe, Beau-Salinas, Frédérique, Taillé, Camille, Dieudé, Philippe, Crestani, Bruno, Diot, Patrice, Marchand-Adam, Sylvain
• Format: Journal Article
• Language: English
• Published: United States 01.10.2011
• Subjects: Adalimumab; Administration, Inhalation; Adult; Aged; Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized - adverse effects; Antibodies, Monoclonal, Humanized - therapeutic use; Asthma - chemically induced; Asthma - diagnosis; Asthma - drug therapy; Female; Humans; Infliximab; Male; Middle Aged; Rheumatic Diseases - drug therapy; Steroids - administration & dosage; Steroids - therapeutic use; Treatment Outcome; Tumor Necrosis Factor-alpha - antagonists & inhibitors
• ISSN: 1931-3543
• DOI: 10.1378/chest.10-2350

We report five cases of asthma unmasked by anti-tumor necrosis factor (TNF)-α-blocking drugs. Asthma symptoms appeared within an average of 4 months (range 1-24 months) after starting the anti-TNF-α treatment for inflammatory disease. The patients did not appear to be predisposed to asthma except for one patient who had asthma during childhood. Four patients stopped anti-TNF-α-blocking drugs with an improvement of symptoms within 1 to 5 months. In the patient with a history of childhood asthma, respiratory symptoms recurred when another anti-TNF-α therapy was started. Asthma control was achieved with inhaled steroids, allowing anti-TNF-α treatment to continue. The biotherapy was maintained for the fifth patient in association with inhaled steroids. The pathophysiologic mechanisms are unknown but are probably more complex than the T helper 1/T helper 2 imbalance suggested in the literature, and further studies are required.